Brain Made More Vulnerable To Strokes By Bottleneck In Blood Supply

A team of UC San Diego physicists and neuroscientists has discovered a bottleneck in the network of blood vessels in the brain that makes it vulnerable to strokes. The finding may explain the origin of the puzzling damage to the brain??™s gray matter often detected in brain scans, especially among the elderly.

In the study, published this week in the journal Proceedings of the National Academy of Sciences, the researchers used a laser technique they developed to precisely monitor changes in blood flow resulting from an induced blockage in a tiny artery, or arteriole, in the brains of anesthetized rats. They found that the penetrating arterioles, which connect the blood vessels on the brain??™s surface with deeper blood vessels, are a vulnerable link in the network.

“The blood vessels on the surface of the brain are like a collection of city streets that provide multiple paths to get somewhere,” explained David Kleinfeld, a professor of physics at UCSD, who led the team. “If one of the vessels is blocked, blood flow quickly rearranges itself. On the other hand, the penetrating arterioles are more like freeways. When blocked, the blood flow is stopped or slowed significantly in a large region round the clot.”

The obstruction of blood flow resulted in damage to the surrounding brain area, which the researchers report resembled damage seen in the brains of humans and thought to be the result of “silent strokes.” Silent strokes have attracted attention recently because magnetic resonance imaging has made it possible to follow changes in the brains of individuals as they age. MRI scans have revealed that, over time, small holes accumulate in the gray matter of many patients, including those who have no obvious behavioral signs of a stroke.

The researchers say their results support the hypothesis, made by clinicians, that the penetrating arterioles may be the location of small strokes that cause the death of sections of brain tissue in humans. The accumulation of damage may lead to memory loss, and may be a risk factor for having a larger stroke, according to Pat Lyden, a professor of neurosciences at UCSD??™s School of Medicine and head of the UCSD Stroke Center.

“This damage is an enormous problem,” said Lyden, who collaborated with Kleinfeld on the study. “We think it is part of the dementia picture in Alzheimer??™s and non-Alzheimer??™s patients. But until now, we had no insight into the mechanism of the damage, and understanding the mechanism is the first step toward understanding how to prevent it.”

To determine what happens in the brain during a stroke, the researchers created a tiny clot in a blood vessel in the brain of an anesthetized rat. They used focused laser light to excite a dye they had injected into the bloodstream. A chemical reaction of the excited dye “nicked” the blood vessel at the target location and triggered the natural clotting response.

“The technique creates a clot while generating very little collateral damage,” said Beth Friedman, an associate project scientist working with Lyden in neurosciences and a contributing author on the paper. “Then we can study blood flow changes to understand what is happening in the brain in real time.”

Before and after the formation of the clot, the researchers tracked the movements of red blood cells using two-photon fluorescence microscopy. Two-photon fluorescence microscopy is a powerful imaging tool that uses brief (less than one-trillionth of a second) laser pulses to peer below the surface of the brain.

In contrast to a previous study, in which the team showed there was very little disruption in blood flow when a clot formed in the blood vessels on the surface of the brain, a blockage in the penetrating arterioles had a significant effect. The flow of red blood cells was reduced far downstream of the blockage. Because blood flow cannot simply take alternate routes to compensate for the blockage, the penetrating arterioles are a bottleneck in the blood supply to gray matter.

“In this study, we took advantage of being able to see into individual capillaries in brain tissue,” explained Nozomi Nishimura, who was a graduate student working with Kleinfeld in physics at the time of the study. “It is the capillaries, the smallest blood vessels, that provide the brain cells with oxygen and nutrients. So we were able to measure the dynamics of blood flow where it really matters to nerve cells.”

Nishimura was the first author on the study and is now a postdoctoral fellow at Cornell University working with Chris Schaffer, an assistant professor of biomedical engineering. Schaffer, who also contributed to the study, was an assistant project scientist working with Kleinfeld and Lyden at the time of the discovery.

The study was supported by the National Institutes of Health and the National Science Foundation.

Contact: Sherry Seethaler

University of California – San Diego

Respirology Editor Honored For Work In Respiratory Medicine

Editor-in-Chief of Respirology, Professor Philip Thompson, was conferred the highest award the Asia Pacific Society of Respirology (ASPR) can possibly offer – the inaugural ASPR Society Medal.

Conceived by the ASPR – one of the largest respiratory societies in the world -the Medal was awarded to Professor Thompson in recognition of his significant contributions to the practice of respiratory medicine in the Asia Pacific region, his efforts in turning Respirology into a world leading journal as well as for his 10 years of service on the ASPR’s Executive committee.

This inaugural award was presented to Professor Philip Thompson, Director of the Lung Institute of Western Australia (LIWA) at the Annual Conference of APSR in Bangkok recently.

Professor Thompson said, “I am extremely honored to be given such an award that reflects the views of my peers whom I value and admire so much. I am also very conscious that there are many other deserving individuals who have worked so hard for the APSR and respiratory medicine in the region who equally deserve public recognition”.

Based at Sir Charles Gairdner Hospital in Nedlands, Western Australia, LIWA researches treatment of respiratory and allergic diseases. Dr. Lieve Bultynck, manager of the editorial office of Respirology said, “LIWA and all of the editorial staff at Respirology are delighted with Professor Thompson’s award as it pays tribute to all the hard work involved in running the Journal. It also recognizes the importance of having a publisher like Wiley-Blackwell who has been so supportive of all our endeavours.

About the Asia Pacific Society of Respirology (ASPR)

The APSR is one of the largest respiratory societies worldwide with 13,000 members. It has grown in considerable stature over the last 8 years. It represents all of the countries in the Asia Pacific Region with its key membership base being made up of members of the Japanese, Taiwanese, Korean, Philippine and Australian and New Zealand Thoracic Societies. Other countries involved include Thailand, Singapore, Malaysia, Bangladesh, Hong Kong and China. The APSR is one of only six members of the Federation of International Respiratory Societies.

About Respirology

Respirology is a journal of international standing, publishing peer-reviewed articles of scientific excellence in clinical and experimental respiratory biology and disease and its related fields of research including thoracic surgery, internal medicine, immunology, intensive and critical care, epidemiology, cell and molecular biology, pathology, pharmacology and physiology.

About Wiley-Blackwell

Wiley-Blackwell was formed in February 2007 as a result of the acquisition of Blackwell Publishing Ltd. by John Wiley & Sons, Inc., and its merger with Wiley’s Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal. For more information on Wiley-Blackwell, please visit blackwellpublishing or interscience.wiley.

About Wiley

Founded in 1807, John Wiley & Sons, Inc. has been a valued source of information and understanding for 200 years, helping people around the world meet their needs and fulfill their aspirations. Since 1901, Wiley and its acquired companies have published the works of more than 350 Nobel laureates in all categories: Literature, Economics, Physiology/Medicine, Chemistry and Peace.

Our core businesses include scientific, technical, medical and scholarly journals, encyclopedias, books, and online products and services; professional/trade publishes books, subscription products, training materials, and online applications and websites; and educational materials for undergraduate and graduate students and lifelong learners. Wiley’s global headquarters are located in Hoboken, New Jersey, with operations in the U.S., Europe, Asia, Canada, and Australia. The Company’s Web site can be accessed at wiley. The Company is listed on the New York Stock Exchange under the symbols JWa and JWb.


Asthma – Can Reducing Salt Intake Help?

A new study, funded by Asthma UK, carried out at Nottingham University, UK, will look at the effects of a reduced salt diet on people with asthma. Team leader will be Dr. Andrew Fogarty.

If findings indicate this is so, there will be more justification for a public health intervention to lower the amount of salt people consume nationally.

Recent studies have indicated that people with asthma who consume a lot of salt benefit from a lower intake – especially exercise-induced asthma, according to a recent US study.

This new study will look at how sodium restriction can control asthma generally. Dr. Fogarty said ‘If this proves beneficial then a low salt diet is an easy and simple way to help improve asthma symptoms. This could represent a huge advance in the management of this common condition.’

Dr Fogarty and his team will study 220 volunteers, all of them have asthma. They will be given a salt-reduced diet. Then they will be divided into two groups. One will carry on, on the low salt diet, while the other will be on a diet containing the UK national average salt intake. The trial will last six weeks. The aim will be to see if asthma levels and frequency are any different between the two groups during and at the end of the period.

Dr Lyn Smurthwaite, Asthma UK’s Research Development Manager, said ‘Reducing salt in our diets is thought to be beneficial for many reasons, and the possibility that it may improve asthma symptoms is something Asthma UK is keen to explore. We are delighted to fund Dr Fogarty’s work which may result in an additional asthma management option for some people with asthma.’

National Salt Awareness Week runs in the UK this year from 28 January – 3 February.

Asthma UK


Phase III Study Showed Rituxan® Decreased The Progression Of Joint Damage In Patients With Early Rheumatoid Arthritis

Genentech, Inc. (NYSE:DNA) and Biogen Idec (Nasdaq:BIIB) announced today that a Phase III clinical study of Rituxan® (rituximab) in patients with early rheumatoid arthritis (RA) who have not previously been treated with methotrexate (MTX) met its primary endpoint.

In this study, known as IMAGE, patients received two infusions of either 500 mg or 1000 mg of Rituxan or placebo for up to two treatment courses in combination with a stable dose of MTX. At week 52, only patients in the 1000 mg treatment group met the primary endpoint and showed significantly less progression of joint damage compared to patients who received placebo in combination with MTX. Joint damage was assessed by changes in X-ray images using the Genant-modified total Sharp score.

In both Rituxan treatment groups, secondary endpoints showed a significantly higher proportion of patients with a substantial improvement in RA signs and symptoms (including ACR scores and DAS remission) compared to patients receiving MTX alone. Further analyses of the data are ongoing and will be submitted for presentation at an upcoming medical meeting.

“The study results with Rituxan plus methotrexate in this early RA population are important because the majority of joint damage — a leading cause of disability in patients with RA — is believed to occur within the first two years of the disease, often before traditional disease-modifying drugs like methotrexate have been prescribed,” said Hal Barron, M.D., Genentech’s senior vice president, Development and chief medical officer. “The results from IMAGE reinforce our belief that B cells play an important role in the underlying disease process in RA.”

“The IMAGE study results provide further support for initiating a B-cell targeted agent earlier in RA treatment,” said Evan Beckman, M.D., Biogen Idec’s senior vice president of Immunology Research and Development. “The study results also confirm Rituxan’s positive impact on disease activity and physical function in RA patients. We look forward to sharing the full data set with the medical community and the FDA.”

The safety profile of Rituxan was consistent with our previous experience and a preliminary analysis did not reveal any new or unexpected safety signals. The incidence of adverse events and serious adverse events including infections and serious infections were comparable between Rituxan and placebo treatment groups. The companies continue to monitor the long-term safety of Rituxan treatment.

About the IMAGE Study

IMAGE is a multi-year, Phase III, randomized, double-blind, placebo-controlled, parallel group, multicenter international study designed to evaluate the safety and efficacy profile of Rituxan in combination with a stable dose of MTX compared to MTX alone, in methotrexate-na??ve patients with active rheumatoid arthritis. Methotrexate is a commonly used disease-modifying, anti-rheumatic drug (DMARD). The primary objective of the study was to determine the efficacy of Rituxan in the prevention of progression of structural joint damage and to evaluate the safety of Rituxan in patients with active, early rheumatoid arthritis initiating treatment with MTX.

A total of 755 MTX-na??ve patients with active RA from 168 study sites across 27 countries were randomized to receive either Rituxan (500 mg or 1000 mg) or placebo by intravenous infusion on days 1 and 15, in addition to therapy with MTX. Eligible patients who were not in DAS28-ESR remission 24 weeks following their previous course received a further course of RTX with the same dose as the first course. The primary endpoint evaluating change in total Genant-modified total Sharp scores was measured at week 52.

About Rheumatoid Arthritis (RA)

RA is a debilitating autoimmune disease that affects an estimated 1.3 million Americans and hinders daily activities. The damage that occurs in RA is a result of the immune system attacking joint tissue, causing painful chronic inflammation and irreversible destruction of cartilage, tendons and bones, which often results in disability. Common RA symptoms include inflammation of the joints, swelling, fatigue, stiffness and pain. Additionally, since RA is a systemic disease, it can affect other tissues such as the lungs and eyes.

About Rituxan®

Rituxan, discovered by Biogen Idec, is a therapeutic antibody that first received FDA approval in November 1997 for the treatment of relapsed or refractory, low-grade or follicular, CD20-positive, B cell non-Hodgkin’s lymphoma. It was also approved in the European Union under the trade name MabThera® in June 1998. Rituxan received FDA approval in February 2006 for the treatment of diffuse large B-cell lymphoma (DLBCL) in combination with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) or other anthracycline-based chemotherapy regimens in previously untreated patients.

In February 2006, Rituxan also received FDA approval in combination with MTX to reduce signs and symptoms in adult patients with moderately-to-severely active RA who have had an inadequate response to one or more TNF antagonist therapies. In January 2008, Rituxan was approved to slow the progression of structural damage in adult patients with moderately-to-severely active RA who have had an inadequate response to one or more TNF-antagonist therapies. Rituxan is the first treatment for RA that selectively targets immune cells known as CD20-positive B cells. Rituxan does not target the entire immune system.

CD20 is not found on stem cells, pro-B cells (B cell precursors), normal plasma cells, or other normal tissues. Rituxan does not target plasma cells. These cells make antibodies that help fight infections.

Rituxan does not target stem cells in the bone marrow, and B cells can usually regenerate and gradually return to normal levels after retreatment with Rituxan in about 12 months for most patients.

In addition, Rituxan received FDA approval in September 2006 for first-line treatment of previously-untreated patients with follicular NHL in combination with CVP (cyclophosphamide, vincristine, and prednisolone) chemotherapy and also for the treatment of low-grade NHL in patients with stable disease or who achieve a partial or complete response following first-line treatment with CVP chemotherapy.

Over the past ten years, there have been more than 1 million patient exposures to Rituxan.

Rituxan is also being studied in other autoimmune diseases with significant unmet medical needs, including lupus nephritis and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis.

Rituxan Safety

Rituxan has been associated with fatal infusion reactions, tumor lysis syndrome (TLS), severe mucocutaneous reactions, and progressive multifocal leukoencephalopathy (PML).

Hepatitis B reactivation with fulminant hepatitis, other viral infections, cardiovascular events, renal toxicity, and bowel obstruction and perforation have also been observed. Patients should be closely observed for signs of infection if biologic agents and/or disease modifying anti-rheumatic drugs (DMARDs) other than methotrexate are used concomitantly.

The most common adverse reactions in Rituxan-treated RA patients are hypertension, nausea, upper respiratory tract infection, arthralgia, pruritus, and pyrexia.

The most common adverse reactions (incidence ?‰? 25 %) in Rituxan-treated NHL patients are infusion reactions, fevers, chills, infection, asthenia, and lymphopenia.

For additional safety information, please see full prescribing information, including Boxed Warnings and Medication Guide available at 1-800-821-8590 or gene

About Genentech

Founded more than 30 years ago, Genentech is a leading biotechnology company that discovers, develops, manufactures and commercializes medicines for patients with significant unmet medical needs. The company has headquarters in South San Francisco, California and is listed on the New York Stock Exchange under the symbol DNA. For additional information about the company, please visit gene.

About Biogen Idec

Biogen Idec creates new standards of care in therapeutic areas with high unmet medical needs. Founded in 1978, Biogen Idec is a global leader in the discovery, development, manufacturing, and commercialization of innovative therapies. Patients in more than 90 countries benefit from Biogen Idec’s significant products that address diseases such as lymphoma, multiple sclerosis, and rheumatoid arthritis. For product labeling, press releases and additional information about the company, please visit biogenidec

View drug information on Rituxan.

Mayo Study Examines Link Between Rheumatoid Arthritis And Chronic Lung Diseases

For decades, researchers have suspected a connection between chronic lung diseases and rheumatoid arthritis (RA). Previous research has yielded widely varying estimates about the strength of this connection, partly because studies have used different diagnosis criteria for these diseases. Addressing this problem, Mayo researchers presented preliminary data at the American College of Rheumatology Annual Meeting confirming that patients with rheumatoid arthritis are clearly affected by chronic lung diseases.

The goal of this study is to more precisely measure the cumulative incidence of lung diseases among people with rheumatoid arthritis. Mayo researchers studied a group of 603 people who met strict American College of Rheumatology Annual Meeting diagnosis criteria for RA, examining the subjects’ medical records from diagnosis through their death or last follow-up appointment.

Two pulmonologists and two rheumatologists also studied the subjects’ records for evidence of chronic lung disease. Using a list of strict diagnosis criteria, individual physician’s diagnoses, pulmonary function testing results, X-rays and biopsy findings, they estimated the cumulative incidence of obstructive lung disease and diffuse parenchymal infiltrative lung disease (DPILD) in the study group.

Significant findings

A total of 603 RA subjects were followed for a median of 14 years. The cumulative incidence of obstructive lung disease using the list of diagnosis criteria was 4.1 percent at 10 years after RA diagnosis, 9.5 percent at 20 years and 15.5 percent at 30 years. The observed incidence of DPILD using these criteria was even higher: 7.2 percent, 15.5 percent and 22.4 percent after 10, 20, and 30 years, respectively.

“Having good data that supports a link between rheumatoid arthritis and chronic lung diseases is just the first step,” says Eric Matteson, M.D., Mayo rheumatologist and the study’s lead researcher. “We now need additional research to explore the most effective treatment strategies for these patients and to clarify how these diagnoses impact the quality of life and incidence of mortality in these patients.”

Collaboration and support

The Mayo Clinic research team also included: Yimi Medina, Cynthia Crowson, Sara Achenbach, Sean Caples, D.O., Jay Ryu, M.D., Sherine Gabriel, M.D., and Tim Bongartz, M.D. This work was supported in part by grants from the Mayo Foundation.

Contact: Sara Lee

Mayo Clinic

Kamada Completes Enrollment In Its Phase II Bronchiectasis Trial With Inhaled AAT

Kamada (TASE:KMDA), a biopharmaceutical company engaged in the development, production and marketing of specialty life-saving biotherapeutics, announced recently that it has completed patient enrollment in its Phase II clinical trial evaluating treatment of bronchiectasis patients with inhaled Alpha-1 Antitrypsin (AAT) delivered by the investigational eFlow® nebulizer system (PARI Pharma GmbH).

Chief Executive Officer of Kamada, David Tsur, said, “We are very pleased with the progress of this study and look forward to its upcoming completion. We believe that Kamada’s AAT delivered by PARI’s eFlow® has the potential to become a novel treatment for bronchiectasis. Kamada is committed to the development of inhaled AAT to treat bronchiectasis and to proceed with its ongoing clinical efforts in Alpha 1 Antitrypsin Deficiency and Cystic Fibrosis.”

About the study

A total of 21 patients with brochiectasis were enrolled and randomized into this , double-blind, placebo controlled Phase II study. The purpose of the trial is to investigate safety and efficacy of inhaled AAT in this patient population.

About Kamada’s Inhaled AAT

Kamada’s AAT product has the advantages of a high purity preparation combined with a liquid, ready to use, presentation that does not include stabilizers or preservatives. Efficacy trends towards reduction in lung inflammation were also shown recently by inhaled AAT in a phase II cystic fibrosis study sided to a high safety profile for the given study period.

Kamada’s inhaled AAT, which is delivered via an optimized Investigational eFlow Nebulizer System (PARI Pharma GmbH), has received Orphan Drug Designation from the US FDA for the bronchiectasis indication.

About Bronchiectasis

Bronchiectasis is an abnormal stretching and enlarging of the airways. Bronchiectasis patients usually suffer from recurrent, severe episodes of bronchitis, chronic cough and sputum production. According to the US COPD foundation approximately 600,000 individuals suffer from bronchiectasis worldwide, with an estimated 100,000 people in the US alone (excluding cystic fibrosis patients).

About PARI Pharma and the Investigational eFlow® Nebulizer System

Kamada’s Inhaled AAT is delivered by the Investigational eFlow Nebulizer System (PARI Pharma GmbH). The Investigational eFlow Nebulizer System uses eFlow Technology to enable extremely efficient aerosolization of liquid medications via a vibrating, perforated membrane that includes thousands of small holes that produce the aerosol mist. Compared to other nebulization technologies, eFlow Technology produces aerosols with a very high density of active drug, a precisely defined droplet size, and a high proportion of respirable droplets delivered in the shortest possible period of time. Combined with its silent mode of operation, small size (it fits in the palm of your hand), light weight, and battery use, eFlow Technology reduces the burden of taking daily, inhaled treatments. The Investigational eFlow Nebulizer System and eFlow Technology are proprietary to PARI Pharma and can be optimized to specific drug formulations.

PARI Pharma focuses on the development of aerosol delivery devices and therapies. Based on PARI’s 100-year history working with aerosols, PARI Pharma develops treatments for pulmonary and nasal administration optimized with advanced delivery technologies, such as eFlow technology. Online at PariPharma.

About Kamada

Kamada is a public biopharmaceutical company (kamada) developing, producing and marketing a line of specialty life-saving biopharmaceuticals using its proprietary chromatographic purification technologies. Several of these specialty therapeutics are currently undergoing advanced clinical trials.

Eyal Leibovitz

Asthma UK Cymru Launches Report On The State Of Asthma Services And Care In Wales

Asthma UK Cymru is launching a report ‘A Quarter of a Million Voices??¦.and Counting’, which outlines the challenges facing people with asthma in Wales today and highlights the need for asthma health services in Wales to be vastly improved.

Rates of asthma in Wales are among the highest in the world, with 1 in 12 adults and 1 in 10 children living with the condition. The country also has some of the highest hospital admissions for asthma in the world, with more than 4,000 admissions every year.

While key improvements to the lives of people with asthma are highlighted in the report, new research reveals that:

- An alarming 75% of people with asthma in Wales today do not have a personal asthma action plan, yet many of these people wish to have one.

People with such a plan are four times less likely to require a hospital admission for their asthma and the ‘Service Development and Commissioning Directives: Chronic Respiratory Conditions’ specify that by September 2008, all patients in Wales with chronic respiratory conditions should have individual care plans in place developed between the patient and their healthcare professional.

Asthma UK has personal asthma action plans that can be used as a quick and effective way to assist the introduction of care-plans across Wales.

- People with asthma living in deprived areas of Wales, such as Blaenau Gwent, are most likely to feel that their asthma is out of control, to say that the condition has limited their lives and to have lower expectations of how their asthma treatment can help their condition.

- Despite the advances in asthma medicine and treatment over recent years, 24% of people with asthma feel there is nothing they can do to limit their asthma symptoms and one in seven feel the condition has a negative impact on how other people see them.

Janet Pardue-Wood, National Director of Asthma UK Cymru says: ‘While free prescriptions and smoke-free legislation have helped to ease the burden on the lives of people with asthma in Wales, our report clearly shows there is much more work to be done. When asthma is not controlled effectively, the effects can be devastating and in some cases fatal, which is why improving healthcare and reducing the hospital admissions of the 260,000 people with asthma in Wales is a key aim for Asthma UK Cymru. Our new report “A Quarter of a Million Voices??¦.and Counting” aims to celebrate key policy changes that have made a positive impact on people with asthma in Wales, and highlight how we can further improve their lives.’

Abigail Foster, who has asthma, says: ‘I’m proud to have been part of Asthma UK Cymru’s campaign for free prescriptions, which has made such a difference to people with asthma in Wales. Although my asthma is quite well controlled, I still need six medicines at the moment to do this. If I still had to pay for all these medicines it would soon add up. And if someone like me, who earns an ok wage and makes sure they’ve got their asthma under control, thinks twice about the cost of their medicine, what about someone struggling financially?’

The report will be launched at Asthma UK Cymru’s third birthday event at the Senedd on Tuesday 24 June. Asthma UK Cymru will be joined on the evening by children from Lansdowne Primary School who will demonstrate the impact key policy changes have made on people with asthma during their play ‘Asthma in the limelight’. Guests will include Assembly Members, healthcare professionals and people with asthma.


1. The production of the report ‘A Quarter of a Million Voices??¦.and Counting’ has been sponsored by an educational grant from GlaxoSmithKline.

2. Asthma UK Cymru’s third birthday event at the Senedd is supported by an educational grant from Novartis.

3. For further information, contact the Asthma UK Media Office on 020 7786 4949 or at mediaofficeasthma or the Wales office on 02920 435400.

4. Asthma UK is the charity dedicated to improving the health and well-being of the 5.2 million people in the UK whose lives are affected by asthma. Asthma UK Cymru is dedicated to improving the health and well-being of the 260,000 people in Wales whose lives are affected by asthma.

5. For up-to-date news on asthma, information and publications, visit the Asthma UK website asthma.

6. For independent and confidential advice on asthma, call the Asthma UK Adviceline, which is staffed by asthma nurse specialists. It is open weekdays from 9am to 5pm on 08457 01 02 03. Or email an asthma nurse at asthma/adviceline.

Asthma UK

$1.4 Billion In Assistance To Bogus Hurricane Victims

The American Government has handed out $1.4 billion’s worth of hurricane assistance to bogus claimants. The list of dishonest claimants includes people who managed to acquire football season tickets, vacations, legal help for a divorce, to a prisoner who used a cemetery as his home address claiming to be a hurricane victim.

It seems that 16% of the money handed out did not actually make its way to real hurricane victims, according to a General Accountability Office (GAO) inquiry. Some GAO officials went undercover and found out how easy it was to con the system and get payments from FEMA (Federal Emergency Management Agency). One of the agents managed to make up a fake address and get a $2,358 treasury cheque for rental assistance. Even when FEMA found out the agent did not live at that address it still went ahead with the payment.

The list of scams is like something out of a fiction novel. One claimant managed to get money that paid for a 70-day vacation in a hotel in Hawaii.

Michael, McCaul, chairman of the subcommittee that will conduct a hearing in the House of Representatives today said “This is an assault on the American taxpayer. Prosecutors from the federal level down should be looking at prosecuting these crimes and putting the criminals who committed them in jail for a long time.”

FEMA received a lot of criticism for its slow response to the Katrina disaster. It seems it will be in for even more criticism now. A FEMA spokesman said that it takes the stewardship of looking after taxpayers’ dollars very seriously. He added that FEMA is careful to make sure funds are distributed appropriately.

Although FEMA puts the amount of wrong payments at about $16 million, the GAO says it is almost sure the figure is around $600 million to $1.4 billion. There were many cases of people being paid for their hotel stay while at the same time receiving emergency rental assistance. There were other cases of people being paid thousands of dollars for their stay in a hotel while at the same time receiving rental assistance for multiple locations.

To try to claw back a possible one billion dollars or more will be a monumental task. How many people were involved in scams? If the number is high, the total Katrina bill is going to be massive. To the total amount raised and given out, add to this the bill of trying to get back the money that went to fraudsters, and then add to this the cost of taking them to court for their crimes.


New Diagnostic Criteria For Alzheimer’s Disease

An international group of Alzheimer’s disease (AD) experts have proposed new criteria for the reasearch diagnosis of the condition, as they argue the existing criteria are out of date due to unprecedented growth of scientific knowledge in the field. The proposal is put forward in a Position Paper published early Online and in the August edition of The Lancet Neurology.

AD is a neurodegenerative disease characterised by progressive cognitive deterioration, together with declining activities of daily living and by neuropsychiatric symptoms or behavioural changes. It is the most common form of dementia.

The existing criteria were published in 1984 by the National Institute of Neurological Disorders and Stroke-Alzheimer Disease and Related Disorders (NINCDS-ADRDA) working group.

Dr Bruno Dubois, Salp??tri??re Hosptial, Paris, France, and colleagues, say: “[These existing criteria] are the prevailing diagnostic standards in research; however they have now fallen behind the unprecedented growth of scientific knowledge. Distinctive and reliable biomarkers of AD are now available through structural MRI, molecular neuroimaging with PET*, and cerebrospinal fluid analyses.”

To meet the new criteria for probable AD, patients must show progressive memory loss over more than six months, plus at least one or more of the supportive biomarker criteria. These include: atrophy in a particular part of the brain shown by MRI, abnormal biomarker proteins in the cerebrospinal fluid, a specific pattern on PET of the brain, and a genetic mutation for AD within the immediate family. The authors say: “These new criteria are centred on a clinical core of early and significant episodic memory impairment??¦the timeliness of these criteria is highlighted by the many drugs in development that are directed at changing pathogenesis.”

The researchers add that validation studies are required to advance the new criteria and optimise their sensitivity, specificity and accuracy.

They conclude: “When effective disease-modifying medications are available, the argument for such biologically based studies will be even more compelling.

“These proposed criteria move away from the traditional two-step approach of first identifying dementia according to degree of functional disability, and then specifying its cause. Rather, they aim to define the clinical, biochemical, structural, and metabolic presence of AD.”

In an accompanying Comment, Dr Norman Foster, Center for Alzheimer’s Care, Department of Neurology, University of Utah, USA says: “We should seize this opportunity to reopen the discussion of Alzheimer’s disease diagnosis. The time is right to use the advanced technology at our disposal to improve the early, accurate diagnosis of dementia and develop more effective treatments.”

PET*= Positron Emission Topography

The Lancet Neurology

Link Between Pain Thresholds, Inflammation And Sleep Problems In Arthritis Patients

Despite recent advances in anti-inflammatory therapy, many rheumatoid arthritis (RA) patients continue to suffer from pain. Research published in BioMed Central’s open access journal, Arthritis Research & Therapy found that inflammation is associated with heightened pain sensitivity at joint sites, whereas increased sleep problems are associated with heightened pain sensitivity at both joint and non-joint sites.

Researchers from the Division of Rheumatology and Pain Management Center of Brigham and Women’s Hospital, and the Chronic Pain and Fatigue Center of the University of Michigan Medical School, assessed experimental pain sensitivity, disease activity, sleep problems and psychiatric distress in 59 women with RA. The researchers used questionnaires to assess the women’s sleep problems and psychiatric distress and measured the levels of C-reactive protein as an indicator of disease activity. They also measured pain sensitivity with pressure pain threshold testing at joint and non-joint sites. Lower pain thresholds are indicative of higher pain sensitivity.

“Sleep problems were inversely associated with pain threshold at all sites, suggesting a defect in central pain processing”, state the authors. This finding emphasises the need for research into the mechanisms underlying sleep disorders and pain in RA patients, particularly given the common occurrence of sleeping problems among these patients. This autoimmune disease, causing chronic inflammation, affects nearly 1% of the population and sufferers often report ongoing pain in spite of successful anti-inflammatory treatment.

“Since differences in pain sensitivity may shape the course of pain complaints and influence treatment decisions, it is important to understand the factors associated with enhanced pain sensitivity”, lead author Yvonne Lee says, adding, “Physicians and researchers should consider both inflammatory and non-inflammatory factors when evaluating pain in research settings and in the clinic.”


The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis: a cross-sectional study
Yvonne C Lee, Lori B Chibnik, Bing Lu, Ajay D Wasan, Robert R Edwards, Anne H Fossel, Simon M Helfgott, Daniel H Solomon, Daniel J Clauw and Elizabeth W Karlson
Arthritis Research & Therapy (in press)

Charlotte Webber

BioMed Central